Many problems that patients experience during chemotherapy can be managed similarly to how they are managed outside of cancer. Some problems are unique and require specialised approach, therefore referral to a specific flow chart or protocol may assist. These unique aspects relevant to cancer are summarised below.
When problems occur, it is important to identify which ones constitute an emergency requiring resuscitation and hospital admission, and which can be safely managed at home. If the patient is managed at home, it is useful to schedule a review for the patient in 2 to 3 days to ensure that the problem has resolved.
Rapid Assessment and Access Toolkit Resources are available to assist in identifying and prioritising the presenting problems:
Rapid Assessment & Access Toolkit
Telephone triage log sheet
The following resources and management guidelines are also available on the eviQ website as well as external websites:
Myelosuppression commonly occurs 7–14 days post chemotherapy. Neutropenic sepsis is a life-threatening toxicity and should be treated as a MEDICAL EMERGENCY. Patients can deteriorate rapidly and die within hours. Neutropenic patients do not mount a normal immunological response to infection. As such, it is important to treat any symptoms with suspicion and urgent referral to the hospital is required. Prompt action reduces the risk of death from neutropenic sepsis.
|Nausea and vomiting
Chemotherapy induced nausea and vomiting uncontrolled by prophylactic medication is best managed by addition of an agent from a different drug class. The choice of agent should be based on assessment of the current prevention and strategies used. Some patients may require several agents with differing mechanisms of action.
- Ensure fluid resuscitation
- Consider regular around the clock administration rather than as required dosing
- If mild nausea, add metoclopramide 10 mg orally three times a day (maximum 30 mg/24 hours, up to 5 days)
- If more severe and within 1 to 2 days after chemotherapy, add dexamethasone 4 mg orally twice daily, up to 2 days (if appropriate)
- Seek cancer team advice if not resolved in 2 days
- Feedback to the cancer team to amend future doses of antiemetics with subsequent cycles of chemotherapy
- For further information see Management of breakthrough emesis
- Ensure good oral care including:
- mouthwash at least four times a day
- regular tooth brushing with soft toothbrush
- maintain adequate fluid intake
- topical or oral analgesia as required
- referral to a dietitian if required
- For further information see:
Oral mucositis assessment tool